Does UnitedHealthcare Cover Eliquis?
The verdict
Covered on most plans
Yes — UnitedHealthcare covers Eliquis for AFib and VTE across commercial, ACA, Medicare Part D/Advantage, and Medicaid, managed through the OptumRx PBM. Eliquis is broadly on-formulary; prior authorization is nationally rare on Medicare (0.2% PA, 0% step) and uncommon on commercial plans. The 2026 IRA negotiated Maximum Fair Price is $231 per 30-day supply, and the $2,100 Medicare Part D out-of-pocket cap protects against the highest annual costs. Verify your specific OptumRx plan formulary for tier placement and cost-share.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with UnitedHealthcare using your member ID.
Key facts
Eliquis coverage on UHC/commercial plans is 99.6%; on Medicare it is 99.7% — prior authorization is required on only 0.2% of Medicare plans (MMIT, Sept 11, 2025).
MMIT via GoodRx (as of Sept 11, 2025)
The 2026 IRA Maximum Fair Price for Eliquis is $231 per 30-day supply — a 56% reduction from the prior list price of approximately $521.
CMS Medicare Drug Price Negotiation Program, 2026 MFP
The 2026 Medicare Part D annual out-of-pocket cap is $2,100; once reached on a UHC Part D/Advantage plan, all covered drugs including Eliquis cost $0 for the rest of the year.
CMS Final CY 2026 Part D Redesign Program Instructions
Medicare vs. commercial coverage
Whether UnitedHealthcare covers Eliquis depends heavily on which kind of plan you hold. They follow completely different rules — here's each one, side by side.
Medicare
Part D & Advantage plans
Eliquis is covered on UnitedHealthcare Medicare Advantage and Part D plans, including the Advantage 3-Tier PDL, as a Tier 3 preferred brand. Prior authorization and step therapy are essentially nil — nationally 0.2% PA and 0% step for Eliquis in Medicare (MMIT, as of Sept 11, 2025). As a Part D plan sponsor, UnitedHealthcare must apply the IRA negotiated Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026 (down from approximately $521, a 56% reduction). However, the MFP is a payer-side ceiling, not an automatic fixed copay: as the USC Schaeffer Center/JAMA analysis (Feb. 14, 2025) documented, average Eliquis out-of-pocket costs in stand-alone Part D plans more than doubled from 2020 to 2024 as plans shifted from fixed copays to coinsurance. The 2026 Medicare Part D out-of-pocket cap of $2,100 (CMS Final CY 2026 Part D Redesign) limits your annual exposure; once reached, Eliquis costs $0 for the rest of the benefit year. LIS/Extra Help enrollees pay $0–$12.65 per month. Medicare beneficiaries cannot use the BMS commercial copay card.
Commercial / Employer
Group & marketplace plans
UnitedHealthcare is the largest US commercial insurer, and Eliquis is covered across its employer and ACA plans via the OptumRx PBM. Nationally, MMIT data (Sept 11, 2025) shows 99.6% commercial coverage and 100% ACA coverage for Eliquis. OptumRx operates a Step Therapy program for select high-cost drugs, but Eliquis step therapy is nationally rare — only 0.9% of commercial plans require it. Prior authorization applies in approximately 8.1% of commercial plans. Tier placement varies by specific UHC commercial plan; verify on your OptumRx formulary. UHC Community Plan Medicaid covers Eliquis with nominal cost-share; PA is applied in a minority of states (MMIT Medicaid 12.2% PA nationally). The BMS commercial copay card (~$10 per fill) is available for commercially insured patients not enrolled in a government program; Medicare and Medicaid enrollees are not eligible. BMS also offers a direct-to-patient program at approximately $346 per month for uninsured patients.
Your cost, three ways
What Eliquis actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
Approximately $550–$800 per 30-day supply at retail pharmacy (pharmacy-variable estimate). BMS direct-to-patient program: approximately $346 per month.
List price with no coverage — before any manufacturer savings card.
With coverage
Medicare Advantage/Part D: IRA Maximum Fair Price $231 per 30-day supply effective January 1, 2026; $2,100 annual out-of-pocket cap in 2026; LIS/Extra Help $0–$12.65 per month. Commercial/ACA via OptumRx: copay card (~$10 per fill for commercially insured, non-government patients). All figures are estimates — verify with your specific UHC plan.
Typical monthly copay once prior authorization is approved.
All dollar figures are estimates; your actual cost depends on your UHC plan's tier structure, benefit phase, and whether it uses a fixed copay or coinsurance percentage. The IRA Maximum Fair Price of $231 is a ceiling on the payer side — it does not guarantee a specific patient copay. Verify on your OptumRx formulary or call UHC member services. Medicare beneficiaries cannot use the BMS copay card.
Check YOUR exact coverage in 3 steps
General answers only get you so far. Here's how to confirm your own plan's decision in a few minutes.
- 1
Search Eliquis on the OptumRx formulary tool
Visit myuhc.com or the OptumRx drug pricing portal. Search for Eliquis (or apixaban) and select your specific 2026 UHC plan to see the exact tier, any prior authorization requirement, and estimated copay or coinsurance. OptumRx formulary information is plan-specific, so the results will differ between commercial, Medicare Advantage, and Medicaid plans.
- 2
Call UHC member services
Call the number on the back of your UHC ID card. Ask: (1) What tier is Eliquis on my OptumRx plan? (2) Is prior authorization or step therapy required? (3) What will my cost-share be after my deductible? Having your plan ID and drug dosage handy speeds up the lookup.
- 3
Ask your prescriber about Medicare savings programs if you are a Part D enrollee
If you are on UHC Medicare and have limited income, the Extra Help (Low Income Subsidy) program can reduce Eliquis costs to $0–$12.65 per month. Your prescriber or pharmacist can point you to the Social Security Administration to apply, or you can check eligibility at Medicare.gov.
Options if UnitedHealthcare won't cover Eliquis
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Xarelto (rivaroxaban)
Another oral DOAC covered by UHC plans, with a 2026 IRA negotiated price of $197 per 30-day supply. Available through OptumRx as a Tier 3 drug. Discuss with your prescriber whether Xarelto is appropriate for your indication.
Warfarin (generic)
Low-cost generic anticoagulant (Tier 1–2 on most OptumRx plans). Requires regular INR monitoring. Not appropriate for all patients — discuss with your prescriber.
Apixaban generic (~2028)
No FDA-approved generic apixaban is expected until approximately 2028. Once available it would likely carry lower tier placement and cost-share on UHC/OptumRx formularies.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes — UnitedHealthcare covers Eliquis for AFib and VTE across its commercial, ACA, Medicare Advantage/Part D, and Medicaid plans, managed through OptumRx. It is on-formulary on essentially all UHC plans (MMIT: 99.6% commercial, 99.7% Medicare coverage nationally as of Sept 11, 2025). Prior authorization is required in a minority of commercial plans and is nearly nonexistent on Medicare. Verify your specific tier and cost-share on the OptumRx formulary.
Not typically. OptumRx runs a Step Therapy program for select high-cost drugs, but Eliquis step therapy is nationally rare — only 0.9% of commercial plans require it (MMIT, Sept 11, 2025). On Medicare, 0% of plans require step therapy. If you receive a step-therapy denial on a UHC commercial plan, your prescriber can file an exception documenting why Eliquis is medically necessary, which is the standard appeals process.
CMS negotiated an Eliquis Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026 — a 56% reduction from the prior list price of approximately $521. UHC Medicare Advantage and Part D plans must apply this price. However, whether you personally pay less depends on your plan's cost-sharing structure. The USC Schaeffer Center (JAMA, Feb. 14, 2025) found that average Part D patient costs for Eliquis more than doubled from 2020 to 2024 as plans shifted to coinsurance.
Starting in 2026, UHC Medicare Part D and Advantage plans are subject to the $2,100 annual out-of-pocket cap (CMS Final CY 2026 Part D Redesign). Once your total out-of-pocket drug costs reach $2,100, all covered drugs — including Eliquis — cost $0 for the rest of the year. This is particularly important for patients who take multiple high-cost drugs. The prior donut hole structure has been eliminated; cost now flows through three phases ending at the $2,100 cap.
Only if you are on a commercial or ACA plan from UnitedHealthcare — not on Medicare, Medicaid, or CHIP. The Bristol-Myers Squibb Eliquis copay assistance card (~$10 per fill) is valid for commercially insured patients who are not enrolled in any government health program. If you have UHC Medicare Advantage or Part D, the copay card cannot be used. LIS/Extra Help enrollees may qualify for reduced costs of $0–$12.65 per month through the federal subsidy.
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Read moreThis content is for informational purposes only and does not constitute medical, financial, or insurance advice. Coverage rules, prior-authorization criteria, and copay amounts change frequently and vary by plan, formulary tier, and effective date — always verify current benefits directly with UnitedHealthcare before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.